What are the signs and symptoms of locked in syndrome? Where does an infarct causing these symptoms localize?

• respiratory distress
  
• no horizontal eye movements
  
• ability to communicate appropriately using eye blinks or vertical eye movements
  
• no voluntary movements of extremities
  

This constellation of signs and symptoms, called locked in syndrome, localizes to the brain stem. Specifically, respiratory distress suggests medullary involvement and the other findings suggest bilateral involvement of the pons. The fact that consciousness and vertical eye movements are preserved mean that the midbrain is spared.

Blumenfeld, H. MD., PhD. Neuroanatomy through Clincial Cases. 2002.